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Patients shouldn’t have to be patient

There is an alarming new condition which affects approximately five per cent of all A&E patients. Television programmes such as Casualty rarely show it, but in reality you will not complete a shift without hearing the dreaded words: "That patient is breaching!"

They reflect one of the Department of Health's "top-down" targets: that A&E patients must be treated within four hours. Hospitals achieving this for 98 per cent of patients can receive a £100,000 bonus every three months (for equipment but not pay packets, unfortunately).

Many A&E departments are now obsessively focussed on the target, and have members of staff with the sole purpose of preventing any patient breaching the time limit.

Doctors often moan that patients cannot be properly assessed within four hours and that the standard of


dr andrew harrison is glad hospitals are committing to a four-hour deadline

care is suffering. But actually, I suspect they hate having a manager telling them to get a move on.

And, everyone else is getting nagged too: the radiology department, the blood testing laboratories and any hospital service which is slowing down the progress of a patient.

I worked briefly in an A&E department which was not attempting to implement the target. There was equal pressure to work fast, but it came from patients waiting to be seen, their aggravated relatives, and my fear that someone far back in the queue might be seriously ill. The resulting stress was worse because I didn't have support from other parts of the hospital.

So, despite the unpopularity of 'top-down' targets, I am a fan of the four-hour deadline. In fact I avoid working in hospitals that are not committed to it.

FIRST POSTED OCTOBER 18, 2006